5 - 83.6) and 64.8 % (95 %CI 53.1 - 74.9) respectively. The pooled rate of adverse events was 8.0 % (95 %CI 5.2 - 12.2). The pooled rates of enteroscopy and technical success of DBE-ERCP (four studies) were 83.5 % (95 %CI 68.3 - 92.2) and 72.5 % (95 %CI 52.3 - 86.4), respectively. The pooled rate of adverse events with DBE-ERCP was 9.0 % (95 %CI 5.4 - 14.5). Substantial heterogeneity was noted. Conclusions OAE-ERCP appears to be effective and safe in post-RYGB patients. Among the currently available techniques, OAE-ERCP is the least invasive approach in this challenging group of patients. Future studies comparing the effectiveness and safety of alternative novel techniques, such as endosonography-directed transgastric ERCP, with OAE-ERCP are needed.History A 58-year-old man presented with refractory hypokalemia and rapid weight gain. https://www.selleckchem.com/products/ph-797804.html On examination, he had high blood pressure, central obesity and bilateral pitting edema. Findings and diagnosis Biochemical tests showed hypokalemic metabolic alkalosis due to ACTH-dependent hypercortisolism. CT of thorax and abdomen revealed a pulmonary and a right adrenal mass. Biopsy of the pulmonary mass led to the diagnosis of an ACTH-producing small cell lung cancer. Treatment and course Under treatment with ketoconazole and chemotherapy a tumor response was reached and the hypercortisolism was controlled. Since the right adrenal mass remained stationary under chemotherapy, an incidental adrenal adenoma seemed the most likely diagnosis. Conclusion The diagnosis of paraneoplastic Cushing's syndrome can be challenging, since classical clinical features of hypercortisolism may still be absent, even if the underlying cancer is already advanced. Therefore high clinical suspicion is warranted, especially in patients presenting with new-onset refractory hypokalemia, metabolic alkalosis and arterial hypertension.Psoriatic arthritis is a heterogeneous immune-mediated disease that usually involves skin and joints but can also affect entheses and extraarticular structures in the disease course. In addition, associated diseases must be considered when choosing the appropriate therapeutic strategy. Different recommendations for treatment of psoriatic arthritis are available for clinical use. The recommendations of the European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) are the two internationally accepted guidelines frequently used to assist therapeutic decisions in clinical practice. New targeted treatment options developed based on a better knowledge of critical pathogenic pathways, will enlarge our armamentarium for optimized pharmacotherapy of psoriatic arthritis and improve personalized patient care.Accumulating evidence suggests that a symptom-driven therapy with fixed combinations of inhaled corticosteroids (ICS) and formoterol is safer and more feasible in patients with mild asthma than a treatment with short-acting beta-2-agonists (SABA) alone. Therefore, the new international GINA asthma guideline (2019) recommends, for the first time, as needed low dose ICS-formoterol as the preferred controller in treatment step 1. This radical paradigm shift will have a major impact on asthma care in the future.Several interventional trials that studied cardiovascular safety of antidiabetic drugs in patients with diabetes mellitus and elevated risk of cardiovascular disease suggested potential nephroprotective effects of SGLT-2 inhibitors. Subsequently, the CREDENCE study confirmed reduced progression of chronic kidney disease (CKD) towards dialysis-dependency in diabetic patients with mildly or moderately impaired glomerular filtration rate and high albuminuria. Next, the DAPA-CKD and EMPA-KIDNEY studies were initiated to test whether SGLT-2-inhibitors will also affect CKD progression in (a) non-diabetic CKD patients, (b) in CKD patients without albuminuria and/or (c) in patients with advanced CKD. The premature stop of DAPA-CKD was announced in March 2020 because of overwhelming nephroprotective effects of dapagliflozin. The final publication of DAPA-CKD is expected in late 2020. Parallelly, new treatment guidelines from the Kidney-Disease-Improving-Global-Outcomes (KDIGO)-Initiative will recommend SGLT-2 inhibitors as standard treatment for CKD patients with diabetes mellitus, even though these drugs are not yet licensed for patients with moderately-to-severely reduced renal function.Current pandemic caused by SARS-CoV-2 inducing viral COVID-19 pneumonia, is categorized in 3 stages. Some biomarkers could be assigned to one of these stages, showing a correlation to mortality in COVID-19 patients. Laboratory findings in COVID-19, especially when serially evaluated, may represent individual disease severity and prognosis. These may help planning and controlling therapeutic interventions. Biomarkers for myocardial injury (high sensitive cardiac troponin, hsTn) or hemodynamic stress (NTproBNP) may occur in COVID-19 pneumonia such as in other pneumonias, correlating with severity and prognosis of the underlying disease. In hospitalized COVID-19 patients' mild increases of hsTn or NTproBNP may be explained by cardiovascular comorbidities and direct or indirect cardiac damage or stress caused by or during COVID-19 pneumonia. In case of suspected NSTE-ACS and COVID-19, indications for echocardiography or reperfusion strategy should be carefully considered against the risk of contamination.Acquired thrombocytopenias represent a group of bleeding diseases, which can be mediated by immune or non-immune factors. Acquired immune thrombocytopenia (AITP) leads to an accelerated decrease in platelet count by platelet reactive antibodies arising from several mechanisms. In AITP, autoantibodies, alloantibodies or drug-dependent antibodies are usually targeting platelet surface glycoproteins. The consequence of this is a significant decrease in the number of circulating platelets, leading to clinic pathological disorders including immune thrombocytopenia, heparin-induced thrombocytopenia or drug-induced thrombocytopenia, respectively. The aforementioned disorders are characterized by a severe reduction in platelet count ( less then 20 × 109/l), which is, with the exception of HIT, associated with high bleeding risk. In this review we provide current insight into recent achievements regarding diagnosis and management of AITP.